[Preventative and therapeutic relapse strategies after allogeneic hematopoietic stem cell transplantation: Guidelines from the Francophone society of bone marrow transplantation and cellular therapy (SFGM-TC)].
Fiche publication
Date publication
décembre 2017
Journal
Bulletin du cancer
Auteurs
Membres identifiés du Cancéropôle Est :
Dr DAGUINDAU Etienne
Tous les auteurs :
Yafour N, Beckerich F, Bulabois CE, Chevallier P, Daguindau É, Dumesnil C, Guillaume T, Huynh A, Levrat SM, Menard AL, Michallet M, Pautas C, Poiré X, Ravinet A, Yakoub-Agha I, Bazarbachi A
Lien Pubmed
Résumé
Disease relapse remains the first cause of mortality of hematological malignancies after allogeneic hematopoietic stem cell transplantation (allo-HCT). The risk of recurrence is elevated in patients with high-risk cytogenetic or molecular abnormalities, as well as when allo-HCT is performed in patients with refractory disease or with persistent molecular or radiological (PET-CT scan) residual disease. Within the frame of the 7th annual workshops of the francophone society for bone marrow transplantation and cellular therapy, the working group reviewed the literature in order to elaborate unified guidelines for the prevention and treatment of relapse after allo-HCT. For high risk AML and MDS, a post transplant maintenance strategy is possible, using hypomethylating agents or TKI anti-FLT3 when the target is present. For Philadelphia positive ALL, there was a consensus for the use of post-transplant TKI maintenance. For lymphomas, there are no strong data on the use of post-transplant maintenance, and hence a preemptive strategy is recommended based on modulation of immunosuppression, close follow-up of donor chimerism, and donor lymphocytes infusion. For multiple myeloma, even though the indication of allo-HCT is controversial, our recommendation is post transplant maintenance using bortezomib, due to its a good toxicity profile without increasing the risk of GVHD.
Mots clés
Antineoplastic Agents, therapeutic use, Bortezomib, therapeutic use, Central Nervous System Neoplasms, prevention & control, Genetic Markers, Hematologic Neoplasms, genetics, Hematopoietic Stem Cell Transplantation, Humans, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, drug therapy, Lymphoma, drug therapy, Maintenance Chemotherapy, standards, Multiple Myeloma, drug therapy, Neoplasm, Residual, Prognosis, Protein Kinase Inhibitors, therapeutic use, Recurrence, Retreatment, methods, Secondary Prevention, methods
Référence
Bull Cancer. 2017 Dec;104(12S):S84-S98